INFLUENZA.

Taranaki Daily News, 19 June 1919, Page 5

INFLUENZA.

COMMISSION'S REPORT.

VOLUMINOUS RECOMMENDATIONS. DPENCE DEPARTMENT ARRAIGNED. HEALTH MINISTER CRITICISED. By Telegraph.—Press Association, Wellington, Last Night. Tho report of the Royal Commission charged to make inquiries regarding the influenza epidemic has been made available for publication. Following are the recommendations of the commission:— (1) That various amendments be made to the public health law, as indicated in the report. (2) That the public health law be remodelled, consolidated, and simplified. (3) That clauses be added to the Public Health Act making provision for regulation of prices, equipment of goods and services required in combating an epidemic.

(4) That a business 1 directory be established in connection with the Health Department under the charge of an expert business administrative officer, to be named the "Director of Public Health."

(5) That a chief sanitary inspector for the Dominion be appointed. (5) That the powers, duties, and relations of all public health officers, '.medical, sanitary, and administrative, be fully and clearly defined and published for general information. (7) That an educational system be attached to the business directory for the dissemination of knowledge and Information to the public relating to matters of public health. (8) That greater attention be given in primary and secondary schools to domestio science, hygiene, first aid, and home nursing as subjects for girls in secondary schools, these subjects' to be made compulsory.

(9) That the health of school children be given increased attention through the establishment of school clinics under the charge of qualified medical officers. (10) That we strongly recommend for the favorable consideration of the Government the subsidising of organisations for teaching first aid and home nursing, and especially the St. John Ambulance Brigade and Association to enable it to extend its most useful work.

(11) That the existing health districts be divided into sub-districts and assistant health officers placed in charge under the district health officer.

(12) That cities and large towns with contiguous boroughs and town districts form the local health departments, under the supervision of the Public liealth Department. (13) That health matters in other boroughs and town districts than those referred to in clause 12 be administered by the Government Health Department. (14) That special advisory committees be appointed to report from time to time on the health conditions of the ports and shipping of the Dominion. (15) That constant inspection be made of ships, wharves, and adjuncts of water fronts under the direction of a medical health officer (16) That combined action be taken by the general Government and local authorities to institute and carry into effect schemes for the provision of adequate housing accommodation and the renovation of localities at present encumbered with buildings unsuitable for habitation.

(17) That the Government take part with other Governments in establishing an international bureau for the collection and dissemination of information bearing on the prevention and limitation of disease.

(18) That an annual conference of representatives from all health authorities, boards, and committees be instituted as a means of public' guidance. The commission adds to its report the following paragraph: The commission desires to place on record its admiration of the high public spirit, devotion, and self-sacriice displayed by medical men and nurses in combating the epidemic disease at very great personal inconvenience, risk, and even loss of life- The same commendations apply to members of the police force and to members and officers of many public bodies, also the numerous body of private citizens who laid aside their own private affairs and devoted themselves whole-heartedly to the work of helping the health authorities, both local and general, to save as many as possible of those affected by the epidemic.

The commissioners apologise for the length of time the inquiry occupied, and mention that this was due to the fact that the Department of Public Health, including the Minister, avowedly considered the Department to be on trial, and in consequence prepared and presented numerous reports on a great variety of subjects. The commission rejects as incredible the suggestion mado.by the bacteriologists and pathologists of the Department that our epidemic of influenza was admittedly identical with pandemic influenza, which was suffered in every part of the world and could be developed from our ordinary, simple influenza with the aid of some new organism into a more virulent form. If it was introduced from without it must have been sea-borne, and the question remaining was: By what vessel or vessels it came ?

.The incident of the Makura is dismissed as of very minor importance, This vessel arrived on November 30, after the epidemic was raging, and was quarantined.

Then the report goes on to discuss the incident of the Niagara. Much evidence is quoted with but little comment. A point is made of a wireless message received from the ship by a naval intelligence officer and telegrams from Auckland health officers. Then the commiaFioners say: "It is difficult to see how the Minister could be satisfied by those communications in the face of the earlier official information from the ship as to the condition of things, which, if true, made her a menace to the health of the city. It is also difficult to understand how the health officers on board the vessel accepted the diagnosis of the acting ship's doctor as to the form and character of the sickness without (as far as appears) any reference to or explanation of the compromising telegram."

CAUSE OF THE SPREAD OF THE DISEASE. The commissioners find that, although severe influenza existed in New Zealand prior to the coming of the Niagara, they are not satisfied that any of these have been shown to be cases of the epidemic form of tha disease. In support of the contrary view, the opinion of the Auckland branch of the British Medical Aa.

sociation is cited. The commission rejects the suggestion that the disease could be spread from Narrow Neek Camp. On this part of the inquiry the commission finds:—

(a) That the cause of the introduction of the recent epidemic of influenza into New Zealand was the conveyance by the sea of the infective element of the epidemic influenza lately prevalent in Europe, Great Britain, South Africa, and America.

(h) That the extension of the epidemic from its first appearance in Auckland was largely the result of a general disregard of precautionary measures in the initial stages, due to want of knowledge regarding the nature of the disease. Infection was largely spread by the congregation of large crowds of people in various centres of population in connection with the armistice celebrations, race meetings, carnival week in Christchurch (which large numbers of visitors from all parts of the Dominion attended), and the fact that no restriction was placed upon the movements of people in travelling, even when they had been in contact with infected persons.

THE NIAGARA. In regard to the Niagara: (a) That, although the matter is not one capable of absolute demonstration, the evidence before us raises very strong presumption that_ a substantial factor in the introduction of the epidemic was the arrival in Auckland on October 12 of the Niagara with patients affected with the epidemic disease; (b) the evidence does not exclude the possibility of other sources, suck as the presence of infection from other vessels arriving in Auckland at the same time or shortly before the arrival "of the Niagara; (c) the foregoing evidence proves, in our opinion, that official action before, in and about the release of the Niagara showed either the non-recognition or disregard of the gravity of the position described by the wireless message of October 11.

HEALTH DEPARTMENT'S ADMINISTRATION.

The next section of the report deals with the Health Department administration as relating to the epidemic. Some faults are found with the administration,, and with the advice given in the beginning of October by medical officers of the Department. Reference is made to the understaffed condition of the Department, and the conclusion is made that the Department ought to be strengthened by additions or by providing some qualified reserve officers who might be called upon in case of the leading officers being temporarly disabled. The commission finds that the chief faults of administration arose from: (a) The local (Auckland) branch of the Department being understaffed; (b) chief offices not having sufficient power of direction; and (c) the official attitude towards the disease in postulating a distinction between "simple ibfiuenza" and "virulent" as if only the latter were infectious or of danger to the community:

The report advises more port precautions and a better health inspection of the waterfront, including the supervision of shipping commissioners', dealing with housing and sanitation.

BAD HOUSING CONDITIONS.

The report continues: From our inspections and the evidence submitted, we are confident that considerable improvements are required in respect to the conditions in which large numbers of people in our cities are required to live. It was most evident that the bad conditions existing -,vere due to an inheritance of a wrong sub-division of land, the continuous habitation of old, dilapidated, worm-eaten, vermin-infested, and in some instances really rotten structures, the economic factors of the short supply of decent houses, and excessively high rents, and personal habits of uncleanliness of a proportion of the tenants. Whilst borough councils appear to give very full attention to the general sanitary requirements;, there is no doubt that in all the centres groups of houses and, in some places, nearly whole streets are stated to be a constant menace to public health in that the houses are quite unsuitable for habitation. With a proper regard to health, particularly that of women and children, the commission says they urge most strongly that there is need for the closest combination between the general Government and local authorities towards the institution of completely national plans for dealing promptly with this most serious national and municipal problem, as the general health of our people is undoubtedly the Dominion's greatest asset. The reform of existing bad conditions should be entered upon, even if the initial financial cost is great, as the added efficiency of a completely healthy people would replace the expenditure entailed in carrying out the much delayed schemes of reconstruction.

HEALTH MINISTER IN DEFENCE. THE NIAGARA CASES. Wellington, Last Night. Hon. Or. W. Ruasell, in a statement regarding the epidemic report, says the delay in publication was caused by incorrect reference to his evidence, he being made to Bay he received warning in September to prepare for an epidemic, whereas the following passage appeared in his evidence: "I now wish to deal with the approach of the Niagara, and I feel it due myself to-say thai no warning was given me as Minister of Public Health that it was necessary New Zealand should take steps to prepare for a possible inroad of this pandemic to this country."

The Minister challenges the fairness of the commission, and especially of the chairman, in refusing to allow him to quote from Auofcland. newspapers to show the existence at the time the Niagara arrived of a virulent form of influenza.

The Minister adds: "It is admitted, of course, that the disenso became much more deadly a week or two after the arrival of the Niagara, but what are the facts? Only two patients from the Niagara died. Tho report of the commission states that a man was admitted on O'tober 12, having been previously gassed. He was therefore more liable to contract a virulent form of infection than another person, as his lungs were not normal. The commission quotes Dr. Maguire as saying: "Tho first influenza eases began to come into hospital from the same date as the arrival of the Niagara," yet no sane person would suggest these had been infected from the ship.

The Minister proceeds: "The Niagara arrived in Auckland on Sunday, October 13, and the position was that on that date Auckland was practically in flames with the epidemic. I am not prepared as a layman to suggest that the arrival of the Niagara did not accentuate the position; possibly the arrival of that abip may have brought a more rirukM

form of influenza bacilli, which in its new hosts and in entirely fresh environment developed into a scourge which spread | over tie (Dominion and resulted in so many deaths. On the other hand, seeing the pandemic was world-wide and that influenza was slaying' its hundreds of thousands in other countries of the world at the Bame time that the onslaught in New Zealand took place, it appears to me there is no necessary connection between the arrival of the Niagara and the disaster which happened. "All the commission can find is 'a very strong presumption' that the Niagara was 'a substantial factor.' When she left Vancouver she was absolutely a clean ship, and the influenza epidemic was not current at that place. A few days after leaving a female passenger was found to be suffering from a mild form of influenza. She recovered in due course. The vessel 1 cached Tahiti. There, also, there was no disease, and there was no sign of disease till some days after leaving Tahiti. By the time the vessel had arrived at Suva a number of stewards were ill, and practically between that port and her arrival at' Auckland a large number of cases brdke out. I have stated this for the purpose of showing how, when once the epidemic of influenza began upon that ship, it grew in virulence until on arrival in Auckland there were, no doubt, some serious cases on board. The deaths of the Niagara patients, were very small in number, as ia shown by the commission's report. "In the report the commission blames me as Minister for accepting the reports of the public health officers as to conditions on the Niagara. They say I did not ask for a report 'in general terms,' (but I did ask for a report on two specific questions. The reply of the health officer was that there had been one death the day before the arrival of tho ship, and that the disease was 'purely simple influenza.' On this I gave authority for the ship to be cleared.

"The commission refers to what it describes as 'an ominous telegram' received from the captain of tlie snip on Saturday. The captain did, it is true, mention a number of cases of Spanish influenza on board the vessel, and that. 25 would require to go to hospital. 'Spanish influcraa' is not a scientific term; it means nothing. When the disease broke out in Spain it wai in ft very mild form. On the other hand, it is clearly shown in the evidence that the health officer at Auckland (Dr. Hughes) and the port health officer (Dr. Russell) both visited the ship. They discussed matters with two doctors on board who had been attending the cases, Dr. MacKenzie and Dr. Barnett, and it was after they had seen cases and obtained a diagnosis of the doctors on board that they replied that the disease was purely simple influenza. Would any body of rational men suggest that "a lay Minister in charge of a department should refuse to accept the advice of his responsible experts and officers and place more reliance upon a telegram from the captain of a ship than upon four doctors, two of whom were on board throughout the voyage, and two of whom had made perfectly independent diagnosis of casesf The suggestion ia too preposterous for words, yet that is the suggestion of the commission. As I told the commission in my evidence, "it is very easy to he wise after the event,' and I also eaid that %e would be a foolish Minister of Health who had not learned from experience of the pandemic.'" The Minister traverses the commission's findings at length, stating that when the Niagara arrived the Health Department had no quarantine stations available, as they were held by the Defence authorities. The Department, with the assistance of all classes, had cleared up the disease in a little over three weeks, and now the country was clean and there had been no recrudescence, though the disease was still going strong in South Africa and Australia. 'T. fear the commission was. less concerned to be just than to try and prove the Health Department lacking," states the Minister.

MASKS NOT TO BE REVIVED YET. By Telegraph.—Press in- Copyr'ght. Received June 18, 10.5 p.m. Sydney, June 18. Cabinet, after an exhaustive review of the influenza situation, decided not fb revive masks at presentDISEASE SPREADING. Sydney, June ISThe bitterly cold weather is conducive to the spread of influenza. Since the outbreak there have been 2230 deaths in the State, of which 1670 have been in the metropolitan area.—Aus.-N.Z. Cable Assn.